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Truvada missed doses and possible exposure

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Lex:
I have scoured the internet for Truvada or HIV hotlines available 24hours or on weekends and it seems itís been a bust so Iím hoping you guys can help me.  I apologize if this isnít the right forum.

I am fairly new to anal sex and have found condoms to hurt me as a receptive partner even with lots of lube. Maybe from a lack of experience. I am not very sexually active but I decided to go to an infectious disease doctor to get put on truvada and Iíve been on it since February. Iíve been taking it daily up until very recently. Iíve had an issue with my pharmacy that caused a delay in getting my prescription so for about a week, Iíve been taking the pill every other day to try to extend my current bottle. I took a pill Wednesday night at bedtime and skipped Thursday night. Friday I got my 30 day refill so I am back on a daily schedule. Friday night, I had a sexual encounter with someone I have known briefly. We talked beforehand and he believed he was STD free. Since I donít know him well, I asked him to wear a condom anyways but it was extremely painful. In the heat of the moment and knowing I'm on Truvada, I allowed him to go bareback. He ejaculated inside me. When he left, I went to take my bedtime medications, including Truvada, and it struck me how this was the first pill Iíve taken in 48 hours. This got me to thinking and I would like to ask advice:

1. I know Truvada is highly effective even at just 4 days a week but how long does it stay in your system? After 48 hours, was my system basically Truvada free and I had no protection?

2. I know Truvada used to be given as PEP alone. I took Truvada less than a hour after the potential exposure and now that I have my month supply, will be taking it daily for the next month. Would that be efficient for a PEP treatment in this scenario? Since I am within the 72 hour window, should I seek out the 3rd anti-viral medicine included in the current PEP regiment?

I see my infectious disease doctor in about 3 weeks for my PrEP 3 month testing. She also does a full STD screening too. She has told me the blood test she does can detect HIV as early as 2 weeks from infection (unless I misunderstood) so I should know fairly soon. I am just worried that the few missed doses this week may have been a huge mistake.

Thanks in advance for all advice.

Jim Allen:
Hi

So if part of your safer sex plan is having unprotected intercourse in part based on someone's last test results its a sure way to catch HIV and/or other STI's.

Anyhow as for the Truvada as PrEP you are on, it takes time to build up the levels required in the tissue to provide the high level of protection PrEP offers. That said it does require following the dosing to maintain that high level of protection in your system and tissue, so having "gaps" would or could reduce the overall level of protection offered.

If you are thinking about switching to PEP than make sure to do this as soon as possible no later than 48 -72 hours post exposure. The decision is up to you and your Doc at the end of the day.

Jim

Jim Allen:
I moved your thread to "How Can I Prevent HIV" so others might chime in on this.
Just do stay within this section of the forum.

Jim

Lex:

--- Quote from: JimDublin on April 23, 2016, 03:53:37 pm ---So if part of your safer sex plan is having unprotected intercourse in part based on someone's last test results its a sure way to catch HIV and/or other STI's.
--- End quote ---

My safe sex plan is to be on Truvada, talk to my sexual partners about their statuses, and use condoms as often as possible. Last night, condoms were used initially but removed during sex. In the moment, I thought it would be fine for HIV prevention since I am currently on PrEP. The recent missed doses is what is given me concern. I have missed approximately 3 doses in the last 7 or 8 days, typically on a day on day off pattern until my insurance was fixed.

[/quote] If you are thinking about switching to PEP than make sure to do this within the 48-72 hours post exposure and the decision is up to you and your Doc at the end of the day. [/quote]

I am considering switching but I am wondering if Truvada alone for the next 30 days is sufficient. I feel I would have had at least some medicine in my system from almost 2 months of daily use. And after the 48 hour gap, I did take truvada less than a hour after potential exposure.

Do you have any kind of hotline I can call that would be available 24 hours or on weekends?

Jim Allen:
The safer sex part of it, well I guess you already know what I think about that part of your plan. Enough said.

Look if you only missed 3 doses in the last 8 days but have been taking the Truvada as PrEP correctly since February you should have some level of protection. The Ipergay study shows us that even with planned gaps some level of protection is offered, however the level of Truvada dosage was different in that study. (I'm not recommending taking PrEP this way but it's just as example)  http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/

Look your situation is not ideal. I mean it's prescribed as a daily dose and you did miss a few doses so i would say that does not mean no protection but it could very well affect the level of protection.  It's up to you if you want to switch to PEP to be sure following your exposure. 

Now I don't know of any hotline that is open myself. Others might know depending on your location. This forum has members from all over the world, so all I can recommend is for you to talk to your Doc.

Jim

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